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Patient case: Nephrotic Syndrome in Sub-Saharan Africa.

Patient details
Patient details.
Name: Amina Age: 7 years Gender: Female Residence: Rural village in Northern Nigeria Occupation of parents: Subsistence farmers
Patient case fields
Presenting Complaint

Amina's parents brought her to the local clinic after noticing progressive swelling around her eyes and ankles over the past two weeks. Initially, the swelling was worse in the mornings but later persisted throughout the day. They also reported a significant reduction in her urine output and that her urine appeared "foamy" on several occasions. Amina has been increasingly lethargic and complains of generalized weakness. There is no history of fever, cough, or recent infections, but the family lives in an area with known malaria and schistosomiasis prevalence.

Past Medical History

Amina has no significant medical history. Her vaccinations are up to date. The family uses untreated river water for drinking and household purposes.

Physical Examination

Vital signs: Normal blood pressure, afebrile

General appearance: Amina appears puffy, especially around her face and ankles. She is malnourished, with visible stunting.

Cardiovascular and respiratory: Normal heart sounds, clear lung fields.

Abdomen: Mild ascites, no tenderness

Extremities: Pitting oedema in both lower limbs

Laboratory Results:

Urinalysis: Heavy proteinuria (+++), no haematuria

Serum albumin: Low (hypalbuminaemia)

Lipid profile: Elevated cholesterol and triglycerides

Renal function tests: Creatinine and urea levels within normal limits.

Diagnosis

Based on the clinical presentation, laboratory findings of heavy proteinuria, hypalbuminaemia, and hyperlipidaemias, Amina is diagnosed with nephrotic syndrome, likely secondary to minimal change disease (MCD), a common cause of nephrotic syndrome in children.

Plan and Management

Given the rural setting, limited access to tertiary care, and the high prevalence of infections like malaria and schistosomiasis, Amina is started on:

  1. Prednisolone: To address the underlying glomerular disease.
  2. Diuretics (Furosemide): For managing edema.
  3. Nutritional support: To improve her malnourished state.
  1. Antibiotic prophylaxis: Given the high risk of infections due to her immunocompromised status.
  2. Health education: Counselling the family on clean water use and the importance of monitoring her urine output and general condition.

Referral to a regional hospital for further evaluation and possible renal biopsy is planned if her condition does not improve with steroid therapy.

Discussion
No data was found
Questions
1. What is the most likely diagnosis for Amina based on her clinical presentation and laboratory findings?

a). Acute glomerulonephritis

b). Nephrotic syndrome

c). Urinary tract infection

d). Chronic kidney disease

2. Which of the following is the most important finding that supports the diagnosis of nephrotic syndrome?

a). Hypertension

b). Proteinuria

c). Hematuria

d). Hyperkalemia

3. What is the first-line treatment for nephrotic syndrome in children, as seen in Amina's case?

a). Antibiotics

b). ACE inhibitors

c). Prednisolone

⁸d). Dialysis

4. What complication is A at increased risk for due to nephrotic syndrome?

a). Hypertension

b). Infections

c). Diabetic nephropathy

d). Renal artery stenosis

Reveal answers

Answers

  1. b) Nephrotic syndrome
  2. b) Proteinuria
  3. c) Prednisolone
  4. b) Infections

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